Provider Demographics
NPI:1376899898
Name:MUCHNICK, MARCIA D (LMP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:D
Last Name:MUCHNICK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2600
Mailing Address - Country:US
Mailing Address - Phone:360-913-0058
Mailing Address - Fax:
Practice Address - Street 1:1075 NE 7TH AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2600
Practice Address - Country:US
Practice Address - Phone:360-913-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA#60299077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist